Are Prozac and Other Psychiatric Drugs Causing the Astonishing Rise of Mental Illness in America?
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At some later point, however, as the chemical imbalance story repeatedly fell apart, psychiatrists in the research community understood that they were telling a “fib.” I can still remember -- this was the summer of 1998 -- when I questioned a prominent academic psychiatrist about whether the chemical imbalance story was really “true” and he replied by stating that it was a “useful metaphor” that “helped patients understand why they needed to take their medication.” This really is the tragedy of modern psychiatry -- it became a medical discipline devoted to telling a public story that made its drugs look good, as opposed to telling a story rooted in honest science.
BL: Big Pharma and their partners in establishment psychiatry would like the general public to believe that the only critics of psychiatry are Scientologists. In reality, most scientists who are critics of psychiatry are also critics of the pseudoscience of Scientology. It is my experience that serious critics of psychiatry are not anti-drug zealots. For example, I know that you have talked with “psychiatric survivors” -- ex-patients who want to reform mental health treatment. David Oaks, one of the leading activists in the psychiatric survivor movement, often repeats that some members of his MindFreedom organization continue to take their psychiatric drugs while many choose not to, and what MindFreedom and other psychiatric survivors are fighting for is truly informed choice and a wider range of treatment options. Do you think that David Oaks’ fight is the right one?
RW: Big Pharma and its partners in establishment psychiatry have smartly used Scientology to defuse criticism of their medications. I honestly believe that if Scientology weren't around, then our society could have a much more rational discussion about our drug-based paradigm of care. As for the position taken by MindFreedom and other psychiatric survivors, I basically do think that is the right one to take, with two caveats.
In order to make a “truly informed choice,” a person needs to know the long-term effects of a treatment. It’s not enough for people to be fully informed about the immediate “side effects” of a drug. People need to be presented with information about whether such treatment has been shown to better the long-term course of the disorder, or worsen it. They need to be told about long-term physical and cognitive problems that often arise with every day use of psychiatric drugs. So providing people with a “truly informed choice” is a tall order.
My second caveat is this: As a society, we expect the medical community to develop the best possible form of care. We do not expect a medical community to offer a therapy that regularly leads to a bad end. And so, if we were to draw up a blueprint for reforming the current paradigm of care, it would be nice if the psychiatric community would try to develop therapeutic approaches that involved using psychiatric medications in a selective, cautious way that best promoted good long-term outcomes. In other words, I think psychiatry does have a responsibility to develop a true evidence-based model for using its drugs, a model that incorporates the long-term outcomes data.
In the solution section of Anatomy of an Epidemic , I write of how doctors and psychologists in northern Finland use antipsychotics in a selective, cautious manner when treating first-episode psychotic patients, and their long-term outcomes are, by far, the best in the Western World. So if you believe in evidence-based medicine, then American psychiatry should look to the Finnish program as a model for reform. Doctors have a responsibility to lead, but I think that you see in David Oaks’ position a belief that establishment psychiatry in America cannot be trusted to provide such leadership. He’s right to believe that, of course, and that's what is so tragic about modern American psychiatry.